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Below is the HillCo client report from the October 6 TDI Reporting Requirements for Health Plan Comparison stakeholder meeting

 
The stakeholder meeting focused on which data would be most useful to consumers in comparing health plans (both HMOs and PPOs) and what difficulties there might be in collecting and presenting that data. As of now, 38 entities have to report this information for comparison, while 70% of all entities are able to report this information. Below is the SB 1731 Health Plan Compare list of elements required by statute – the words in parenthesis describe the difficulty of implementing each task:
 

  • A financial statement of the health of the issuer including its balance sheet and receipts and disbursements for the preceding calendar year, certified by an independent public accountant (simple)
    • TDI proposes using financial data reported by issuers to NAIC
  • The number of individuals enrolled during the preceding calendar year (moderate)
    • TDI proposes to collect this information from issuers via the reporting form
      • Stakeholders recommended providing information on the reason for enrolling or leaving each year (e.g. fraud or transfer)
      • They also questioned the necessity of this request based on the new requirement for annual insurance enrollment
  • The number of enrollees as of the end of the preceding calendar year (simple)
    • TDI proposes using data reported to NAIC
  • The number of enrollments terminated in the preceding calendar year (moderate)
    • TDI proposes to collect the information from issuers via the reporting form
      • Stakeholders questioned whether this information would be more useful on the market or industry level
  • An evaluation of enrollee satisfaction (difficult)
    • Not yet determined: possible resources readily available include NCQA, TDI complaints
      • There was not a clear stakeholder consensus for this information – HMOs provide a satisfaction report card unlike PPOs
      • A clearer understanding of network measures should be addressed – a previous framework should be restructured rather than created
  • An evaluation of quality of care (difficult)
    • Not yet determined: possible resources available include NCQA
      • AARP representative noted that this information should be collected by an independent third-party instead of a self-reporting method
      • Medicare CAHPS survey is a potential model for health plan comparison
  • Coverage areas (simple)
    • TDI proposes using county/rating area filing data
  • Accreditation status (moderate)
    • TDI proposes collecting accreditation status information from issuers via the reporting form
      • Stakeholder suggested including link to SBC information
  • Premium Costs (simple)
    • TDI proposes using filing data
  • Plan Costs (moderate)
    • TDI proposes using preliminary MLR (minimum loss ratio) data reported to NAIC
      • Stakeholders are concerned modifications will lead to less consistency in costs.
  • Premium Increases (simple)
    • TDI proposes using year-to-year filing data
  • The range of benefits provided (simple)
    • TDI proposes collecting URLs to the Summaries of Benefits and Coverage
  • Copayments and Deductibles (simple)
    • TDI proposes using filing data
  • Accuracy and Speed of claims payment (simple)
    • TDI proposes using data from prompt pay reports and complaints
  • The credentials of physicians (moderate)
    • TDI proposes to collect information on the physician credentialing process from the issuers
  • The number of providers (simple)
    • TDI proposes to collect URLs to provider directories from filings and possibly from issuers

 
The meeting was concluded by recognizing the need for a re-evaluation of network adequacy. HMO and PPO disclosures in addition to the TDI annual report should be analyzed to incorporate what already exists into health plan comparisons. Additionally, a TSA representative expressed concern in distinguishing services for individuals in and out of a network on the website.